The quest for a cure
An army of researchers battles an ancient foe
The grey buildings of Montreal’s Royal Victoria Hospital curve like an elderly angel’s wings around a busy uphill driveway. Each day, by taxi, car or on foot, a few of the 200,000 Canadians suffering from cancer climb the drive to receive the chemotherapy, radiation treatment or surgery they pray will keep their disease in check. Sometimes the Royal Vic’s doctors succeed in halting the cancer. Almost as often, the old revolving doors simply exchange patients who come to die in hospital for those preferring to die at home.
The arrivals and departures of patients can be seen across the street from the windows of the McGill Cancer Centre, one of Canada’s dozen research centres dedicated to saving their' lives. The centre’s army of doctors, graduate students and technicians work with an impressive arsenal of glass and metal, sturdy refrigerators marked “radiation hazard,” computers chugging out graphs and particle filtration machines that whirl endlessly. The efforts at this bastion of cancer research are headed by Dr. Phil Gold, a buoyant director with a dazzling research record. He has won nine national and international awards for his efforts to fight cancer— but nonetheless, his words are almost as sobering as the view outside his windows. “You don’t walk into a lab and say, ‘Today I am going to cure cancer,’ ” he says. “All a scientist can do is ask what differentiates the cancer cell from the healthy one. Well, our work here is teaching us a lot. But we may not have the answers.”
Designated “cancer month,” April is the cruelest month. Each spring day, while Canadian Cancer Society fund raisers sell daffodils on street corners, 100 more people die from the disease. Each day, public generosity is made bittersweet by medicine’s continuing failure to decipher cancer and by the relative impotence of treatment. All that is known about cancer is that for some reason normal cells cease to function according to their preordained specializations as controlled by their DNA genetic library’s blueprints, and embark instead on a monomaniacal strategy of endless self-replication. All that is known in mainstream treatment of the disease is to use basic warfare techniques—the knife, poison chemotherapy and radiation bombing—to attack the rebel cells. Since between one-third and one-half of all cancer patients die within five years of diagnosis, the medical profession readily admits that conventional therapy is inadequate.
As old and naturally occurring as human life, cancer is at the centre of this century’s hypochondria, the perceived punishment for industrialization and pollution. Everything a person does, feels or makes seems to be linked to cancer: stress, sexual promiscuity, celibacy, chlorinated water, asbestos in the air, formaldehyde insulation in houses, chemical waste in the ground, artificial grape flavoring, coffee, photocopying machine fluids, smoked meats, barbecued meats or, according to a recent Japanese study, cooked foods period. Dr. Samuel Epstein, author of The Politics of Cancer (1978), has used the word “epidemic” to predict further increases in cancer, and figures seem to bear him out. Today as many as one Canadian in five can expect to suffer from cancer compared to one in six at the turn of the century. It’s small comfort to explain that more Canadians are dying of cancer because fewer are dying of polio and war; people are more obsessed by their fear than ever.
The involvement of the Canadian public in helping Terry Fox raise $23.4 million for the National Cancer Institute of Canada (NCIC) to distribute for research has focused anxious public expectation on the country’s medical community. Former U.S. president Richard Nixon’s “war on cancer”—a half-billion-dollar annual gift to research from 1973 to 1975 —was declared a medical Vietnam following reports of fudged figures, favoritism in grant-giving, private industry influence and its ultimate failure to find a cure for one single form of cancer. As a result, a credibility gap now exists between the public and the research community. Will Canadian doctors have anything more to show for their money than their American counterparts have? The unsatisfying but honest answer is that only a few more tiny pieces of this intricate biological puzzle will likely be assembled. Last week, the NCIC announced it was granting a total of $20.7 million to Canadian cancer scientists for 286 research projects. As in the past, most projects focus on enhancing diagnosis, refining conventional treatments and reducing their side effects, and on studying why healthy cells become malignant. Once again, the choices will be bitterly criticized. Surveying the NCIC’s choices of the past, Dr. David Horrobin, himself a member of an NCIC panel in 1977, once commented: “We’re all failed experts who’ve failed to find a cure— and so we’re unable to evaluate the new. That’s why you get the same old lookalike projects.”
Invariably, such harsh criticism of the NCIC’s priorities falls back on the socalled “cancer establishment.” The NCIC panel members—the doctors and academics who invite other approved doctors and academics to join the NCIC— are clearly part of the establishment, as are the volunteers of the NCIC’s sister organization, the Canadian Cancer Society (CCS). As the source of four-fifths of the NCIC’s money, the CCS has considerable influence on research policies. It is also a powerful organization in its own right, raising $20 million annually, twice as much money per capita from Canadians as does its American counterpart. A typical member of the 100,000-strong CCS volunteer network is Madeline O’Donnell of Goose Bay, Labrador (“We pitched in and cleaned house for a terminal lady patient who was feeling kinda unable”). But the CCS’s image is more often personified by such socially prominent volunteers as Katherine Robarts, wife of John Robarts, the former premier of Ontario, and Shirley Black, wife of Conrad Black, the chairman of Argus Corp., whose $250-a-plate dinner and film premiere was one of the highlights of last winter’s social season in Toronto, collecting $100,000. What the CCS socialites and the NCIC scientists have had in common in the past is a fervent commitment to conventional therapies, to the prevailing directions of research and to the CCS motto—“Cancer can be beaten.”
Beating cancer is a hope on which billions of dollars ride—the hope that a cure or group of cures can be found, patented, mass-produced and marketed with the same “magic bullet” effect that antibiotics had on infectious diseases half a century ago. Already chemotherapy, which is not even a wholly successful cancer treatment, is a $200million industry in the U.S. alone. Interferon—the naturally produced protein that may fight cancer—is becoming an even bigger business. In February, when an American company announced it could produce the substance commercially—thereby reducing the cost per gram from $50 million to $100,000—its shares shot up from $6.50 to $43 in hours.
Even more money rides on the hope that finding a cure will circumvent the necessity of a costly clean-up of known carcinogens. The province of Ontario is still reeling from the news that the cost of removing potential carcinogenic asbestos insulation from Metro Toronto public and secondary schools has topped $19 million—seven times the original estimate. It would cost the enormous psychotropic drug industry even more if charges that its products may speed up tumor growth in humans prove to be true. Last January, Dr. David Horrobin made headlines when he claimed that Hoffmann-LaRoche had successfully applied pressure to have him fired from the Montreal Clinical Research Institute, where he had been reporting accelerated tumor growth in rats given diazepam (LaRoche’s trade.name for diazepam is Valium). Undoubtedly, the most wrenching carcinogen to ban is smoking. Though cigarette packages clearly warn that smoking may be dangerous, it would be as easy to stop the St. Lawrence seaway as it would be to ban the products of an industry that contributes $3.2 billion annually to the Canadian economy.
The CCS has justly won international admiration for its beautifully designed kits for public and high school children, and for its 25-year-old, much-copied Industrial Cancer Education Program. But such programs are emphatically not interventionist. Lois Cahill, the nurse who organized the program, explains: “We lecture workers on the signs of cancer and answer their questions. We have never investigated whether our audiences of asbestos workers or uranium workers were themselves reporting higher incidences of the disease. That wasn’t our job.” Nor have broad investigations of carcino-z gens been a major job of the NCIC, which is why author Epstein charges, “Environmental and occupational research in Canada is of a very low order.” It may also be the reason why, when Dr. Horrobin applied to the NCIC for a grant to study diazepam’s effect on the growth of tumors, his application was rejected three times. Last month, the department of health and welfare’s health protection branch committed $200,000 to investigate diazepam’s effect on cancer—apparently contradicting the NCIC’s position that the study was “not worth doing.”
Yet the NCIC’s reluctance is only consistent with its policy of beating cancer through early diagnosis and cure as opposed to preventing it or finding ways of helping its victims cope. Last year, for example, out of 232 grants awarded by the NCIC, only 35 were related to clinical research and epidemiology (the incidence and spread of disease). Only seven looked at practical problems of prevention—the effects of diet, aging, occupational carcinogens—and only one dealt with the quality of patient care. The sort of research projects that more usually find favor with the NCIC are those that enhance existing forms of therapy. Dr. Lloyd Skarsgard of the B.C. Cancer Foundation says a total of $2.1 million has been received in federal, provincial and NCIC grants for the centre’s TRIUMF cyclotron (a machine for basic physics research that accelerates negatively charged atomic particles and targets them at tumors). Last year alone, TRIUMF garnered $250,000 from the NCIC’s budget of $13 million.
Such impressive technological projects are obviously popular with both governmental and NCIC grant panels. But an even greater proportion of funds flows in the direction of “pure” biology-virology projects that examine the impact of viruses on healthy cells and immunology projects that study the body’s natural defence systems and their apparent failure to resist the disease. In the advance guard of such research in Canada is the McGill Cancer Centre’s Phil Gold and his team-mates, Dr. Joe Schuster and Dr. David Thomson. Last year they received $327,000 from the NCIC (bringing the total received from this source and from the federal government’s Medical Research Council to well over $2 million in the past decade). Gold and his co-workers focus on the cell surface. Here molecular structures act as recognition systems—that is, the structures on one cell fit into those of neighboring cells, so each cell recognizes and co-operates with the other members of the tissue. “Cancer,” believes Gold, “seems to occur when these recognition systems are altered.” Researchers still don’t know what causes the alteration. But because Gold himself has found an antigen (a substance that stimulates the production of antibodies) in both adult cancer victims and healthy fetuses, he subscribes to the theory that much of the information that tells a cell to behave in a cancerous way is already stored in the cell’s DNA genetic library before birth. When a cell becomes cut off from its community, it “re-expresses” this old information.
Gold’s research has already led to earlier diagnosis of certain cancers by monitoring changes in the body’s antigen production. He speculates that a cure for cancer could lie in finding ways of attaching an anticancer agent specifically to changed cancer cell surfaces (see diagram). A different “fit” would have to be found for each type of cancer and for each individual patient. This sounds impossibly intricate—but, in fact, is pretty close to what Dr. Tom Stewart, professor of medicine at the University of Ottawa, hopes he has done. Stewart has helped develop a lung cancer vaccine “keyed” to the individual tumors of individual patients, and is currently co-ordinating a joint American-Canadian study, with NCIC support, of his vaccine’s effect on 300 cancer patients.
Yet and this despite intellectual research, the there flow energy of are money “apto parent contradictions,” admits the McGill Centre’s director, Dr. Roger Hand. Hand says, “It’s my belief that the answers lie not at the cell surface but within its DNA library, where somehow a viral intruder puts a new blueprint into circulation.” The working hypothesis is different again at the B.C. Cancer Research Centre. Dr. Richard San, pointing to tanks of tiny blue tropical fish bred to have cancer immunity, says: “The environment is full of carcinogens. The real question isn’t the cell surface, or the cell’s intruders, but the cell’s repair mechanisms. Why can one cell repair the damage better than another?”
The theoretical anomalies are just a small part of the larger frustration of investigators in the field. Phil Gold sighs and confesses: “We’ve been
working on cancer antigens since 1963. The media have reported our ‘breakthroughs’ so many times that I cringe.” His own field, immunology, “may have been oversold to the public.” Dr. Horrobin, speaking perhaps with partisan bitterness and radicalized by his recent experiences with the NCIC, is even harsher. “Because we don’t try the new but keep refining the old, cancer research has come to a dead stop,” he says.
Meanwhile, the orthodox line of attack on cancer is being undermined by evidence that conventional treatments such as chemotherapy and radiation may be cures that kill. Perhaps the most troubling example is acute myologinus leukemia (AML), one of the more common forms of leukemia, which has been recently linked to the aftereffects of treatment for Hodgkin’s disease.
Perhaps the clearest sign that the public is impatient with traditional research is the growing interest in alternative therapies. Though both the controversial Laetrile, an extract of bitter almonds and apricot pits, and Essiac, an herbal tea, cannot be sold in Canada, more and more patients are taking advantage of the fact that they may legally possess them for private consumption. In 1978, public pressure forced Ontario to allow clinical trials of Essiac. This January, California became the 23rd state to legalize Laetrile treatments.
Meanwhile, a cancer underground has sprung up—an odd alliance of environmentalists, holistic doctors, cured patients grateful to alternative therapists and shadowy figures such as Andrew McNaughton, the Canadian involved in the Biozymes stock fraud case, who remains a major Laetrile entrepreneur. They have built an international network of lectures, referral services and patients’ rights groups: The fast-growing 1,700-strong Canada-wide Consumer Health Organization (CHO), for example, has on its board of directors Libby Gardon, sister-in-law of Stephen Roman, president of Denison Mines and the millionaire backer of the Resperin Corporation, which holds the rights to Essiac and which distributes it free. The CHO is also affiliated with the American National Health Federation, whose board includes Andrew McNaughton.
The diet that underground and vitamin build treatments up the holds body’s that defences make more sense than surgery and attacks on tumors which weaken the body. They are beginning to have an impact. In Toronto, Dr. Bob Bruce, a senior researcher at the Ontario Cancer Institute, is leaving his respected office to head a brand new cancer prevention program focusing on diet. In the U.S., the National Cancer Institute is in the midst of its first clinical trials of Laetrile and diet therapies, while at a recent international immunology conference in Paris, French and American researchers reported that vitamin A delayed or decreased tumors in mice by up to 80 per cent.
The NCIC, cautious and conservative, is not yet pursuing these directions of research. But very informally, interest is building. Doctors at the Maxwell Evans Clinic in Vancouver have several patients under surveillance whose cancers appear to have responded favorably to unorthodox treatments administered elsewhere. One is Trudy Brown, a 55-year-old receptionist from Aldergrove, B.C., who flew to the Cydel Clinic in Tijuana, Mexico, for a treatment of Laetrile, vitamin therapy, plus a chemotherapeutic agent, cyclophosphamide, which apparently put her disease into remission.
As the research establishment broadens its inquiries, research priorities seem to be swinging, Phil Gold says, “from the scientific to the social.” When the NCIC first announced its interest in a quality-of-life study of patient care to the research community, nobody knew how to respond. So the NCIC took the unusual step of running a workshop at Toronto’s Guild Inn to teach the researchers how to apply. The NCIC has also funded palliative care projects; its first venture was with Canada’s pioneer project in 1975 at Montreal’s Royal Victoria Hospital.
The palliative care unit takes a revolutionary view of what constitutes medical treatment. The staff includes a musical therapist, a chaplain, home visitors and social workers specializing in bereavement. Jean Cameron was a social worker attached to the unit when she found the lump in her own breast. Today she keeps her pain under control with 100 mg of morphine every four hours and spends much of her. time advising other outpatients on how she has managed to remain so apparently undaunted. “I try to tell them it’s not why you have cancer that’s important,” Cameron says. “It’s the quality of your time left; how well you cope.”
The broadening of research and treatment brings with it the admission from even the leaders of the cancer establishment that prevention is probably the biggest part of beating cancer. A century ago, the medical profession was divided over what to do about cholera. One group, known as “the contagionists,” favored quarantining and treating victims to beat the disease. Another group, “the miasmatists,” took the environmentalist view—that it could only be beaten by building better sewers and drains. Though a cure for cholera was eventually found—a costly process that involves replacing a good portion of the body’s fluids—improved sanitation certainly deserves the lion’s share of credit for victory. So it may be with cancer—a critical mass of environmentalists, prevention therapists and the research establishment together may achieve some sort of breakthrough.
Working with them, but in the front lines of the war, are the patients themselves. Esther Robins is a 47-year-old Calgary nurse and founder of Cansurmount, the fast-spreading patients’ self-help organization. Recently, Robins’ own cancer, lymphocytic lymphoma, suffered a relapse. “But sharing my experiences with other patients helps me cope,” smiles Robins. “Sometimes, when I see how cheerful everyone at our monthly meetings can be, I realize I’m having fun—and I grow optimistic again.” Ultimately, there can be no breakthrough without such hope.
With files from Use Verwey and Joanna Kidd in Toronto.